More Delays on the Road to an Accessible Ontario Health Care System The Wynne Government Announces Unnecessary “Pre-Consultation on Health Care Accessibility Barriers, Before Appointing the Overdue Standards Development Committee to Consult on Barriers in Ontario’s Health Care System —

July 6, 2016

SUMMARY

1. At a Glance

Yesterday the Wynne Government announced an unheard-of “pre-consultation” on what accessibility barriers the promised Health Care Accessibility Standard should address. It is holding a pre-consultation on this, before it appoints a mandatory Standards Development Committee to hold a consultation on this same topic. It is doing so after public servants had over two years in which they did just such an internal consultation on the same topic. No, we are not making this up.

Below we set out the Wynne Government’s July 5, 2016 email to stakeholders, announcing this new “pre-consultation.” We also set out the Wynne Government’s Survey questions regarding this “pre-consultation” and its Discussion Guide.

The Wynne Government sets August 31, 2016 as the end date for making submissions to the “pre-consultation”. It also announces some in-person sessions. Even if you did not receive an invitation to take part, we urge one and all to do so.

We here offer our reflections and seven strong constructive recommendations to the Wynne Government, arising from this announcement.

In brief, this announcement fortunately constitutes the first public glimmer of Government action on its promise to develop a Health Care Accessibility Standard. The Wynne Government promised it would create a Health Care Accessibility Standard fully 17 months ago.

Offsetting that good news, the Wynne Government’s July 5, 2016 announcement illustrates the agonizingly lethargic, slow, needlessly bureaucratic and rudderless way the Ontario Government has been approaching its duty to implement and enforce the Accessibility for Ontarians with Disabilities Act for the past five years. This announcement needlessly injects even more delay into the development of the promised Health Care Accessibility Standard. Ontarians cannot afford any more delays in a process of creating the promised Health Care Accessibility Standard that is far behind schedule.

There is no need nor any requirement for the Government to hold a “pre-consultation” on what to include in a Health Care Accessibility Standard. The Government needs to now appoint a Standards Development Committee to get to work on crafting recommendations for that accessibility standard. The Government never before delayed the development of an AODA accessibility standard with such a “pre-consultation.”

Making this worse, the Government itself has already been conducting its own review of the barriers in the Health Care Accessibility Standard for this very purpose, and has been doing so dating back over two years. If the Wynne Government has been busy as far back as over two years ago, exploring what accessibility barriers exist in the health care system, why did it wait for over two years to ask the public for its input on this? Why did it wait for almost one and a half years after it had already announced on February 13, 2015, that it would develop a Health Care Accessibility Standard?

This delay is all the more unfair since the Government-appointed 2014 Mayo Moran AODA Independent Review Final Report found that after ten years on the books, the AODA has not made a significant difference in the lives of people with disabilities. That Report shows that Ontario is already behind schedule for full accessibility by 2025. On December 3, 2012, Premier Wynne promised that she’d ensure that Ontario is on schedule.

The focus of this “pre-consultation” seems far too narrow. It potentially leaves out important accessibility barriers before the standards development process even gets started.

The AODA Alliance makes these important and constructive recommendations to fix this situation:

1. The Government should immediately initiate the process for appointing the Health Care Standards Development Committee under the AODA. It should not await the results of this “pre-consultation.”

2. The Government should not restrict the range of accessibility barriers in the health care system that the Health Care Standards Development Committee can address.

3. If it is going to go ahead with this needless “pre-consultation” the Government should now commit to immediately make public all the feedback it receives, and should not filter that feedback before releasing it to the public.

4. The Government should now make public a detailed and comprehensive description of the work that the Accessibility Directorate of Ontario and the Health Ministry has done since before Premier Wynne’s May 14, 2014 letter to the AODA Alliance, and up to the present, on assessing where there are accessibility problems in the health care system. This should indicate all the accessibility barriers and other accessibility problems were discovered, and when the Wynne Government conducted and completed that review.

5. If the Government intends to proceed with this “pre-consultation” it should immediately replace its unduly narrow survey questions with ones that explicitly focus on the full range of accessibility barriers that people with disabilities now face in the health care system, and not merely barriers relating to awareness or communication.

6. The Government should widely publicize this “pre-consultation” if it is going to proceed with it, to get wide input from patients with disabilities, their friends and families. Likely very few heard of this seemingly-low visibility Government announcement.

7. The Government should accelerate the process for developing the Health Care Accessibility Standard. Less than 8 and a half years remain for this accessibility standard to be enacted, and for it to ensure that Ontario’s entire health care system becomes fully accessible to patients with disabilities.

2. What This Announcement Means for 1.8 Million Ontarians with Disabilities The Good News

Our first reflection seeks to identify the positive news in this development. This announcement fortunately breaks the Wynne Government’s delay of almost one and a half years in getting the process started for developing the Health Care Accessibility Standard, which it promised it would create 17 months ago, on February 13, 2015. On February 13, 2015, the Wynne Government first announced that it would create a Health Care Accessibility Standard. We then commended the Government for agreeing to do so. We have been pressing the Ontario Government to create a Health Care Accessibility Standard for at least five years.

The Discussion Paper, released along with this announcement and set out below, gives us some insight into the Government’s thinking about the need for the Health Care Accessibility Standard and the barriers facing people with disabilities in the health care system. Despite the serious concerns set out below, it is helpful to get this first glimpse.

3. What This Announcement Means for 1.8 Million Ontarians with Disabilities The Troubling News

The Wynne Government’s July 5, 2016 announcement illustrates the agonizingly lethargic, slow, needlessly bureaucratic and rudderless way that the Ontario Government has, for the past five years approached its duty to implement and enforce the Accessibility for Ontarians with Disabilities Act. The AODA requires the Ontario Government to lead Ontario to become fully accessible to all people with disabilities by 2025. The Ontario Government must do this by enacting all the accessibility standards under the AODA needed to ensure that it leads Ontario to full accessibility by 2025, and by effectively enforcing those accessibility standards.

The action that the Wynne Government announced yesterday is unnecessary. It injects even more delay into the development of the promised Health Care Accessibility Standard. It does so at a time when Ontarians cannot afford any more delays in a process that is far behind schedule.

Ontario desperately needs a Health Care Accessibility Standard to be enacted under the AODA as soon as possible. The longer the Government delays in getting this accessibility standard enacted and enforced, the more unlikely it is that Ontario will reach the mandatory goal of full accessibility by 2025. Right now, Ontario’s healthcare system has far too many accessibility barriers impeding people with disabilities. Even if every health care organization and provider fully complies with every accessibility standard that the Government has enacted, Ontario’s health care system would not become fully accessible to people with disabilities by 2025, or ever. The Government’s Discussion Guide, released yesterday, commendably appears to support that conclusion.

There is no need and no requirement for the Government to now hold a “pre-consultation” on what to include in a Health Care Accessibility Standard. What the Government should do, and indeed what the Government should have done over a year ago, is to appoint a Health Care Standards Development Committee to develop recommendations for the contents of the promised Health Care Accessibility Standard.

Under the AODA, the very first step the Government must take, once it decides to develop an accessibility standard in a particular area like health care, is to promptly appoint an independent Standards Development Committee. That Committee includes representation from the disability community, the health care sector, and other interested sectors of the Ontario economy.

The Standards Development Committee’s job under the AODA is to explore what recurring accessibility barriers exist in the health care system, and to develop recommendations for the Ontario Government on what the Health Care Accessibility Standard should include. Its mandate includes an important power and duty to consult with the public, including people with disabilities, as it develops its recommendations.

The Ontario Government is not bound to follow the recommendations of a Standards Development Committee, appointed under the AODA. Once a Standards Development Committee submits its final recommendations to the Government, the Government can decide how much or how little it wishes to enact. The Government is required to consult the public as part of this final phase in the standards development process under the AODA.

What the Government has announced yesterday is that before it appoints a Health Care Accessibility Standard to consult the public on the accessibility barriers that people with disabilities face in the health care system that the promised Health Care Accessibility Standard should address, the Government will first itself pre-consult the public on the accessibility barriers that people with disabilities face in Ontario’s health care system. This is a wasteful duplication of efforts. It creates counterproductive delays.

It is commendable that the Government did not conduct any such “pre-consultation” before it appointed any of the five earlier Standards Development Committees that it has previously created. They recommended to Government what it should include in accessibility standards in the areas of customer service, transportation, information and communication, employment or the built environment. Two separate Government-appointed Independent Reviews of the AODA, have examined how accessibility standards are developed. They both focused on the need to simplify the standards development process. Neither recommended making it longer, or adding to it a new “pre-consultation” phase that the AODA does not mandate.

Making this July 5,2016 announcement even more unjustifiable, according to Premier Wynne, the Government was already itself conducting its own review of the barriers in the Health Care Accessibility Standard that a Health Care Accessibility Standard could address. The Wynne Government has said that this work was already underway over two years ago.

In the spring 2014 Ontario election, we asked the major political parties to commit to create new accessibility standards in the areas of health care and of education. In response, Premier Wynne promised that the next accessibility standards to be developed under the AODA would address education and/or health care. Premier Wynne wrote us as follows, in her May 14, 2014 letter to the AODA Alliance, which sets out the Ontario Liberal party’s 2014 election pledges on disability accessibility:

“In order to develop a new accessibility standard, the Ministry of Economic Development, Trade and Employment has been actively working with the Ministries of Education, Training, Colleges and Universities as well as Health and Long-Term Care to examine where changes and new standards are required to make our education and healthcare systems more accessible. This important work needs to be done prior to broad consultation with the accessibility community.”

If the Wynne Government has been busy as far back as over two years ago, exploring what accessibility barriers exist in the health care system, why did it wait for over two years to ask the public for its input on this? Why did it wait for almost one and a half years after it had already announced on February 13, 2015, that it would develop a Health Care Accessibility Standard?

This delay is all the more inexcusable since the Government-appointed 2014 Mayo Moran AODA Independent Review found that after ten years on the books, the AODA has not made a significant difference in the lives of people with disabilities. It reported that progress has been described as agonizingly slow, and that accessibility standards enacted to date, while helpful to an extent, are insufficient.

This July 5, 2016 announcement comes just five days after Premier Wynne broke her promise never to weaken any accessibility provisions or protections that people with disabilities won in or under the AODA. Effective July 1, 2016, the Wynne Government has gutted the effective enforceability of the Customer Service Accessibility Standard for the 32,000 private sector organizations with 20-49 employees in Ontario. That includes private sector organizations with 20-49 employees that provide health care services.

Finally, even if the preceding problems were not troubling, the actual focus of this “pre-consultation” seems to be too narrow. The Government’s Survey set out below, focuses on two areas of accessibility barriers, “Disability Awareness and Sensitivity” and “Communication Barriers.” In fairness, the survey says that it is not limited to those two areas. However its explicit focus on only these two kinds of barriers, after two years of planning, is likely not accidental.

This makes the prime focus of the inquiry far too restricted. People with disabilities face a wide range of barriers in the health care system, as in all other parts of our society. Health care facilities too often have physical barriers in the built environment. The Ontario Building code and existing AODA accessibility standards leaves these in place, even if they are easy to fix and even if they are contrary to the Ontario Human Rights Code, so long as the building is not a new construction or undergoing a major renovation. Even the Building Code’s accessibility requirements for new construction are woefully inadequate.

Diagnostic equipment can lack full and proper accessibility. Many other examples abound.

As designed, this “pre-consultation” survey creates a reasonable appearance that the Government may from the outset be seeking to make the entire Health Care Accessibility Standard far too narrow. In many other outreach efforts on accessibility by the Accessibility Directorate of Ontario, it has explicitly focused on a much wider range of accessibility barriers than just those relating to awareness and communication.

Offsetting this concern may be the fact that the Survey also asks about other barriers. It includes:

“While our research has identified the challenges above, we are seeking your advice on other challenges and barriers that an accessibility standard for health care could address.”

We hope we are wrong in this reasonably-perceived concern.

4. Our Constructive Recommendations to the Wynne Government

First, the Minister should not let this duplicative and unnecessary “pre-consultation” hold up work on developing the promised new Health Care Accessibility Standard. The Minister should immediately initiate the process for appointing the Health Care Standards Development Committee under the AODA. That appointment process can get underway and be completed while the “pre-consultation” is going on over the next two months.

Second, the Government should not restrict the range of accessibility barriers in the health care system that the Health Care Standards Development Committee can address. The entire idea that a “pre-consultation” might lead to restrictions on the mandate of the Health Care Standards Development Committee is wasteful and harmful. The Health Care Standards Development Committee, once appointed, must be free to make whatever recommendations it wishes to the Wynne Government. The Wynne Government should not arbitrarily hog-tie the Committee before its work even gets started.

Put another way, it is for the Health Care Standards Development Committee to first advise what areas in the health care system need accessibility action, and to give the Government its best independent recommendations on this. It is not for the Government, through a two year bureaucratic review and then this “pre-consultation”, to potentially cut off any area of pertinent inquiry by the Health Care Standards Development Committee before it even begins its work. This is especially so given the Government’s great delays in getting to start on even appointing the Health Care Standards Development Committee.

The Government’s approach here flies in the face of the design of the AODA. The AODA is designed to first get independent advice provided to the Government by an arms-length Standards Development Committee on what is needed before the Government decides on its plan of action. Here, the Government seems to want to dictate this from the outset.

For example, the Health Consultation Stakeholders Discussion guide seems to have possibly and wrongly pre-decided policy in important areas. It states:

“Development of the new standard would also consider the complex statutory and regulatory environment in which the health care sector functions and seek to address specific regulatory gaps, rather than duplicating or overlapping existing requirements.”

No such prior restriction was imposed on the Transportation Accessibility Standard. If other regulations that address the health care system address accessibility in part, but are insufficient, it should be open to the Health Care Standards Development Committee to recommend that they be replaced or superseded by more effective, comprehensive AODA requirements. The AODA itself trumps any other regulations, including health care regulations, where they provide less accessibility. Pre-existing regulations should not themselves become an arbitrary barrier to the effective work of the Health Care Standards Development Committee.

The Government has in recent years taken the wrong approach of at times carving entire areas of accessibility out of the AODA. The clearest example of this is Ontario’s inadequate Building Code. People with disabilities would be far better off if the Government were to enact proper accessibility requirements for the built environment in an AODA accessibility standard, in alignment with prior unkept promises by Premier Dalton McGuinty which Premier Wynne promised to honour.

Third, if the Wynne Government is going to proceed with this duplicative “pre-consultation,” it should now commit to promptly make public all the feedback it receives. The Government should not filter that feedback before releasing it to the public. That would assist the work of the Health Care Standards Development Committee, once appointed. It would also assist the public, including the disability community, when deciding on the recommendations that they will provide to the Health Care Standards Development Committee.

This could make some lemonade out of this “pre-consultation” lemon. The Government’s Discussion Guide, set out below, makes it appear that the results of the “pre-consultation” will be shared with the Health Care Standards Development Committee. If so, that could be helpful, but only if this “pre-consultation” is conducted in accordance with the recommendations we set out here. We want to be sure that this happens, that the feedback shared will be unedited and unfiltered, and that it will also be immediately shared with the public including the disability community.

We note with serious concern that the AODA Alliance has been effectively frozen out of the multi-year process by the Accessibility Directorate of Ontario and the Health Ministry up to now in dealing with this issue. Neither has reached out to us to be part of this multi-year process. When you see references in the Health Consultation Stakeholders Discussion Guide to input from “stakeholders”, understand that this includes no feedback sought in this process from the AODA alliance, despite our recognized leading role in Ontario in the campaign for accessibility.

This is so, despite the fact that we have had discussions with the Government at all levels on a wide range of accessibility topics. It is especially hard to understand, since it was the AODA Alliance that proposed that the Government develop a Health Care Accessibility Standard, and that has campaigned for this from as far back as at least 2011.

Fourth, the Wynne Government should now make public a detailed and comprehensive description of all the work that the Accessibility Directorate of Ontario and the Health Ministry has done since before Premier Wynne’s May 14, 2014 letter to the AODA Alliance, and up to the present, on assessing accessibility problems in the health care system. This should spell out in detail all the accessibility barriers and other accessibility problems were discovered, and when the Wynne Government conducted and completed that review.

The Wynne Government’s “Health Consultation Stakeholder Discussion Guide, released yesterday, and set out below includes the following:

Building on the governments commitment, the Ministry of Health and Long-Term Care and the Accessibility Directorate of Ontario recently completed a research project to determine gaps in accessibility in Ontarios healthcare system and identify leading practices worldwide.

The research identified Ontario as a leader in establishing proactive accessibility standards, but noted that common barriers to accessibility within the health care sector exist.

The evidence shows that poor communication and negative experiences between health care providers and persons with disabilities are key factors leading to accessibility barriers.

The findings show that these barriers can cause people with disabilities to avoid seeking out health care, create distrust of medical practitioners, and reduce independence and confidentiality.

Barriers to accessibility in the health care sector can ultimately lead to lower quality care including incorrect diagnosis which poses risks to the health and well-being of persons with disabilities.”

That Discussion Guide describes some high-level conclusions from that Government review. The public should be allowed to also see the details, unfiltered. The public has a right of access to that work and any resulting report now. This would save us all time and effort, and avoid our having to re-invent the wheel. We should not have to resort to a Freedom of Information application to get access to such information.

Fifth, if the Wynne Government intends to proceed with this “pre-consultation”, it should replace its narrow survey questions with ones that explicitly focus on the full range of accessibility barriers that people with disabilities now face in the health care system, and not merely those barriers relating to awareness and communication. It should also focus explicitly on, for example, built environment barriers, policy and bureaucratic barriers, technology barriers, just to name a few.

It would be easy for the Government to replace its short survey, set out below, with one that is expanded to explicitly include such barriers.

Sixth, if the Wynne Government wishes to proceed with this “pre-consultation” it should widely publicize it. It should issue news releases and have the Minister and Ministry staff actively seek out media interviews. A limited Government email blast to known stakeholders and a website posting, while helpful, will not reach the vast majority of people with disabilities who face accessibility barriers in the health care system.

From the July 5, 2016 email from the Accessibility Directorate to the AODA Alliance and other stakeholders, set out below, that announces this “pre-consultation”, it appears that this survey may only be directed to a limited number of stakeholder organizations, and not to the broad public. If we are incorrect in this understanding, this should be publicly clarified.

Seventh, the Wynne Government should now commit to accelerate the development and enactment of the Health Care Accessibility Standard. Less than eight and a half years remain to reach a fully accessible health care system. While there is no Health Care Accessibility Standard, Ontario continues to operate a health care system with unnecessary barriers impeding patients with disabilities. New hospitals and other health facilities continue to be built, using public money, without proper standards in place to ensure that they will be fully accessible. Ontario’s Building Code has proven to be insufficient to meet this need.

5. Concluding Thoughts

Had the Wynne Government discussed with us any of this before it released it to the public, we would have been happy to give the Government the advice and recommendations in this Update. We regret that the Government did not. In Premier Wynne’s May 14, 2014 letter to the AODA Alliance, written during the 2014 election campaign, she committed:

“Our government regards our current relationship with you as one of great importance and sees our partnership as a step towards fostering a more accessible and inclusive province.”

We gather that some within the Ontario Government may at times complain that the AODA Alliance has in recent years been critical of the Government’s handling of accessibility issues. We want to assure the Government, all our supporters, and the public that we will commend the Government when it takes positive action. We criticize the Government when it takes troubling action, doesn’t take needed action or fails to keep its word to people with disabilities.

We deeply regret that too often in the past three or four years, the Government has given us far more cause for criticizing than for complimenting. We continue to offer constructive recommendations. And even where (as is the case here) we are justifiably concerned about the Government’s needless “pre-consultation” we nevertheless make sure that we actively spread the word about it, and encourage all to take part in it.

This new development illustrates why it is important for Premier Wynne to show strong leadership on the accessibility issue, as the 2014 Mayo Moran AODA Independent Review had urged.

You can always send your feedback to us on any AODA and accessibility issue at aodafeedback@gmail.com

Have you taken part in our Picture Our Barriers campaign? If not, please join in! You can get all the information you need about our Picture Our Barriers campaign by visiting http://www.aodaalliance.org/2016

We encourage you to use the Governments toll-free number for reporting AODA violations. We fought long and hard to get the Government to promise this, and later to deliver on that promise. If you encounter any accessibility problems at any large retail establishments, it will be especially important to report them to the Government via that toll-free number. Call 1-866-515-2025.

Please also join the campaign for a strong and effective Canadians with Disabilities Act, spearheaded by Barrier-Free Canada. The AODA Alliance is proud to be the Ontario affiliate of Barrier-Free Canada. Sign up for Barrier-Free Canada updates by emailing info@BarrierFreeCanada.org

MORE DETAILS

July 5, 2016 Email to the AODA Alliance from the Accessibility Directorate of Ontario Announcing the Health Care Accessibility “Pre-Consultation”

Good afternoon,

The Accessibility Directorate of Ontario and the Ministry of Health and Long Term Care are holding pre-consultations with stakeholders to identify accessibility gaps and barriers specific to the health care sector.

We are inviting your organization to be part of this process and to provide input on how we can continue the governments work on achieving accessibility for Ontarians with disabilities in the health care sector.

There are two options available to provide input, depending on your time and location:

1) By August 31, 2016, complete a short, confidential survey by clicking on the following link:

2) Attend a 3 hour in-person session offered at the Accessibility Directorate in Toronto (777 Bay Street, 6th Floor, Boardrooms F/G/H) during one of the following days/times:

Tuesday, July 26 from 9:15am 12:30pm

Wednesday, August 10, from 1:15pm 4:30 pm

A teleconference option will be provided for participants who are unable to attend in person

If you plan to attend one of the in-person sessions, please RSVP to Margaret Hageman: Margaret.Hageman@ontario.ca, 416-326-1289 to indicate your preferred session date and any accommodations you require by July 11, 2016.

We encourage you to consult with your organizations and/or boards to inform your feedback on the patient experience of accessibility in health care settings; however, at this time, we ask that only one representative complete the survey and/or attend a session.

An accessible discussion guide and an accessible word survey is attached to this email, and includes background information and guiding principles for the development of an accessibility standard for health care.

If you require a French version, or alternate format copy, please contact Margaret.Hageman@ontario.ca, 416-326-1289.

Thank you for providing us with your input. Any questions about this process can be directed to aoda.input@ontario.ca.

As part of Ontarios Accessibility Action Plan, the Government of Ontario has committed to identifying and addressing accessibility barriers in the health care sector through the creation of a potential new accessibility standard for health care under the Accessibility for Ontarians with Disabilities Act, 2005 (AODA).

The development of an accessibility standard for health care is about addressing barriers to accessibility that persons with disabilities may experience when receiving health care services.

You have been invited to share your thoughts and considerations on the proposed areas of focus of a potential new accessibility standard for health care before government moves to establish a standards development process under the AODA.

The survey will take approximately 10-15 minutes to complete, depending on the detail of the answers provided. Questions with asterisks indicate questions that require an answer. Please answer only those questions which relate to your experience and perspective (ie. as an accessibility champion, healthcare provider, etc.) Responses will remain confidential as per the Government of Ontario’s Privacy Policy.

If you have any difficulty completing the survey, please contact Margaret Hageman at Email: margaret.hageman@ontario.ca or Phone: 416-326-1289

Pre-Consultation on Accessibility in Health Care 2016

Demographic Information Q1-Q3

The following questions are for demographic purposes only.

*1. Which sector below best represents you or your organization? Please select one answer.

The following section provides respondents an opportunity to comment on potential focus areas of a potential new health care standard for accessibility. Potential focus areas were identified through recent research undertaken to determine gaps in accessibility in Ontario’s health care sector.

The findings suggest that a potential health care standard would be most effective in addressing accessibility barriers in the following areas:

1. Disability Awareness and Sensitivity

2. Communication Barriers

Please note that these focus areas are not final.

Disability Awareness and Sensitivity Q4-Q7

Problem: Persons with disabilities may experience insensitivities when interacting with a health care provider. This may lead to mistrust or misdiagnosis, resulting in poorer health outcomes.

Example: Health care providers may prefer to communicate with caregivers or family, leading patients with disabilities to feel ignored or miss important information.

4. What key accessibility barriers do persons with disabilities face when interacting with health care providers?

5. As a patient / person with a disability, what could health care providers do to improve their awareness and consideration of accessibility barriers?

6. As a health care provider, what additional resources would assist your awareness and ability to accommodate the needs of persons with disabilities?

7. How can an accessibility standard for health care help health care providers and patients / persons with disabilities be confident that their key messages have been heard and understood?

Communication Challenges Q8 – Q 10

Problem: Persons with disabilities may face a variety of communication challenges in navigating Ontarios health care sector. This may lead to fragmented or unequal care.

While our research has identified the challenges above, we are seeking your advice on other challenges and barriers that an accessibility standard for health care could address.

11. As a patient / person with a disability, what other accessibility barriers have you experienced in accessing health care services, and how could they be addressed through a new potential accessibility standard for health care?

12. As a health care provider, what other accessibility barriers have you experienced in providing health care services to people with disabilities, and how could they be addressed through a new accessibility standard for health care?

Survey Complete

Thank you for completing the survey. Please send your response back to Margaret Hageman at Email: Margaret.hageman@ontario.ca or Phone: 416-326-1289

Potential Focus Areas for a New Accessibility Standard for Health Care

Purpose

· As part of Ontarios Accessibility Action Plan, the Government of Ontario has committed to identifying and addressing accessibility barriers in the health care sector through the creation of a new accessibility standard for health care under the Accessibility for Ontarians with Disabilities Act, 2005.

· In line with the goals of the Act, the purpose of an accessibility standard for health care would be to benefit all Ontarians by developing, implementing and enforcing a new accessibility standard in order to achieve accessibility for Ontarians with disabilities with respect to health care services.

· You have been invited to share your thoughts and considerations on the proposed focus areas of a new accessibility standard for health care before government moves to establish a standards development process under the Accessibility for Ontarians with Disabilities Act.

The Need for an Accessibility Standard for Health Care

Context

· Ontarios demographic profile is changing. About 1 in 7 people in Ontario have a disability. This is expected to grow to 1 in 5 within 20 years due to our aging population.

· In addition, the number of seniors in Ontario aged 65 and over is projected to more than double from 1.9 million in 2011 to 4.2 million by 2036.

· People with disabilities are more likely to experience illness more frequently and can face barriers meeting health needs in an accessible way.

The Moran Report

· The Second Legislative Review of the Accessibility for Ontarians with Disabilities Act, 2005 was released in February 2015 (the Moran Report). The reviewer heard strong support from the disability community and hospital sector for a new accessibility standard for health care.

· Provost Moran emphasized that the health care sector is serving patients with temporary or permanent disabilities at all times, which sets it apart from other businesses and organizations.

· The Moran Report highlighted stakeholder concerns that barriers to accessibility in the health care sector may not be addressed by current obligations and suggested a targeted approach to developing new requirements.

Research and Evidence

· Building on the governments commitment, the Ministry of Health and Long-Term Care and the Accessibility Directorate of Ontario recently completed a research project to determine gaps in accessibility in Ontarios healthcare system and identify leading practices worldwide.

· The research identified Ontario as a leader in establishing proactive accessibility standards, but noted that common barriers to accessibility within the health care sector exist.

· The evidence shows that poor communication and negative experiences between health care providers and persons with disabilities are key factors leading to accessibility barriers.

· The findings show that these barriers can cause people with disabilities to avoid seeking out health care, create distrust of medical practitioners, and reduce independence and confidentiality.

· Barriers to accessibility in the health care sector can ultimately lead to lower quality care including incorrect diagnosis which poses risks to the health and well-being of persons with disabilities.

Guiding Principles for Developing a Health Care Standard

· Development of an accessibility standard for health care is about addressing barriers to accessibility that persons with disabilities may experience when receiving health care services.

· Building on the recommendations from the Moran Report, an accessibility standard for health care would be targeted and scalable to address specific accessibility barriers. Like all accessibility standards, new requirements would be forward-looking, supporting organizations in identifying, removing, and preventing barriers to support an accessible patient experience.

· The new health care standard would be informed by and aligned with Patients First: Action Plan for Health Care. This broad transformational strategy is focused on placing patient needs at the centre of the health care system and focuses on four core objectives:

Improve Access;
Connect Services;
Inform; and,
Protect.
· The new health care standard would play an important role in this Action Plan by focusing on accessibility rather than access to specific programs and services.

· Development of the new standard would also consider the complex statutory and regulatory environment in which the health care sector functions and seek to address specific regulatory gaps, rather than duplicating or overlapping existing requirements. A new health care standard would be intended to reflect the goal of the Accessibility for Ontarians with Disabilities Act achieving accessibility by 2025.

Potential Focus Areas

A new accessibility standard for health care could be targeted to those areas that focus on the interaction between a person with a disability and a health care provider:
Evidence suggests that the greatest area of initial impact for a new health care standard would be related to the interaction between patients with disabilities and their health care provider.
Health sector stakeholders have indicated that current requirements such as those related to training that guide the interaction between a health care provider and a patient can be ambiguous and would benefit from greater clarity. Potential Focus Areas: Key Questions

· Please consider the questions below in advance, to provide your input on the proposed scope of an accessibility standard for health care.

Area #1: Lack of Disability Awareness and Sensitivity

· Barrier: Patients with disabilities may experience insensitivities when interacting with a health care provider. This may lead to mistrust or misdiagnosis, resulting in poorer health outcomes.

o Example: Healthcare providers may prefer to communicate with caregivers or family, leading patients with disabilities to feel ignored or miss important information.

Questions:

1. What key accessibility barriers do persons with disabilities face when interacting with a health care provider?

1a. As a patient / person with a disability, what could health care providers do to improve their awareness and consideration of accessibility barriers?

1b. As a health care provider, what additional resources would assist your awareness and ability to accommodate the needs of persons with disabilities?

1c. How can a health care standard help health care providers and patients be confident that their key messages have been heard and understood?

Background to Consider:

· Healthcare providers are currently required to complete general training on accessible customer service.

· Healthcare providers are serving patients with temporary or permanent disabilities at all times, which sets them apart from other organizations.

· Recommendations should reflect the complex regulatory environment in which the health care sector functions.

Area #2: Communication Barriers

· Barrier: Patients with disabilities may face a variety of communication barriers in navigating the Ontarios Health sector. This may lead to fragmented or unequal care.

2a. As a patient / person with a disability, what could health care providers do to reduce communication barriers?

2b. As a health care provider, what additional resources would allow you to better accommodate accessibility needs and reduce communication barriers?

Background to Consider:

· Healthcare organizations are currently required to establish policies outlining how goods, services or facilities are provided in an accessible way.

· Health care organizations are currently required to provide information in an accessible format on request, in a timely manner and at no additional cost.

· Communication barriers include a range of systemic practices and procedures, ranging from ensuring accommodation information is noted in patient records to arranging appointments.

· Recommendations should reflect the complex regulatory environment in which the health care sector functions, and consider any overlap with other statutes or federal requirements.

Area # 3: Additional Accessibility Barriers in the Health Care Sector

Questions:

3a. As a patient / person with a disability, what other accessibility barriers have you experienced in accessing health care services, and how could they be addressed through a new accessibility standard for health care?

3b. As a health care provider, what other accessibility barriers have you experienced in providing health care services to people with disabilities, and how could they be addressed through a new accessibility standard for health care?

Background to Consider:

· Please keep in mind that an accessibility standard for health care is about addressing barriers to accessibility that persons with disabilities experience when receiving health care services, rather than on access to services.

· The guiding principles for the development of a health care standard are outlined on pages 2 and 3.

Questions Regarding This Process

· The development of a new accessibility standard is an ongoing, collaborative process.

These initial, targeted consultations are intended to establish an overall framework for a new accessibility standard for health care. Your feedback as part of this process will help shape the proposed focus areas of a health care standard, which would be provided to a standards development committee to consider.

· Opportunity for public comment will be provided during the standards development process, once the Standards Development Committee has submitted an initial proposed standard to government.

· Please direct any questions or comments to the Accessibility Directorate of Ontario, or the Ministry of Health and Long-Term Care:

Accessibility Directorate of Ontario

Phil Simeon – Manager

Standards Development Unit

Phone: 416-326-6222

Email: phil.simeon@ontario.ca
Ministry of Health and Long-Term Care

Joanne Thanos Manager

Strategic Policy and Planning Division

Phone: 416-326-2420

Email: joanne.thanos@ontario.ca

Appendix 1: Accessibility and Health Care Today

· The goal of the Accessibility for Ontarians with Disabilities Act is to achieve accessibility for Ontarians with disabilities by 2025.

· Accessibility standards apply to the public, private and non-profit sectors to identify, prevent, and remove barriers for people with disabilities. The following standards are being phased in across all sectors gradually up to 2021:

Customer Service Standard

· Requires organizations to provide goods, services or facilities in ways that take the needs of people with disabilities into account.

Information and Communications Standard

· Requires businesses and organizations to create, provide and receive information and communications in ways that are accessible for people with disabilities.

Employment Standard

· Requires organizations to establish processes that provide for accessibility across the employment life cycle from recruitment to career development.

Transportation Standard

· Addresses ways to prevent and remove accessibility barriers to public transportation so that everyone, including people with disabilities, can more easily travel in Ontario.

Design of Public Spaces Standard

· Addresses the removal of barriers for people with disabilities in public-use areas, including:

· These five accessibility standards apply to all organizations with at least one employee in Ontario, including public, private and non-profit healthcare organizations.

Appendix 2: Hospitals

· Like all public sector organizations in Ontario, hospitals must meet requirements under the Accessibility for Ontarians with Disabilities Act. Several examples and their specific application to hospitals are provided below:

o Training:

§ Hospitals must ensure training is provided on the requirements of the accessibility standards under the Accessibility for Ontarians with Disabilities Act and the Human Rights Code as it pertains to persons with disabilities.

§ Training must be provided to all employees and volunteers and all other persons who provide goods, services or facilities on behalf of the hospital.

o Multi-year Accessibility Plans

§ Hospitals must establish and maintain a multi-year accessibility plan outlining their strategy to prevent and remove barriers and meet accessibility requirements.

§ They must consult with persons with disabilities when developing, reviewing and updating their plans, as well as post their plan publicly and provide it in accessible formats upon request.

o Emergency Procedures, Plans or Public Safety Information

§ If a hospital has emergency procedures, plans or public safety information available to the public, the hospital will also need to provide them in accessible format or with communications supports when requested by a member of their community or the general public.

o Accessible Formats and Communication Supports for Employees

§ When an employee with a disability requests it, every hospital shall consult with the employee to provide or arrange for the provision of accessible formats and communication supports for information that is:

· needed to perform the employees job;

· and generally available to the workforce.

· A broader list of requirements under the Act with which hospitals with 50 or more employees are currently required to comply is provided below:

General Requirements

· Accessibility Policies

· Multi-year Accessibility Plans

· Procuring or Acquiring Goods, Services or Facilities

· Self-Service Kiosks

· Training Staff

Customer Service

· Allowing persons with disabilities to be assisted by support persons, and to make use of assistive devices, as well as service animals

· The list below identifies some of the common accessibility standards with which independent health facilities with 1-19 employees are currently required to comply under the Accessibility for Ontarians with Disabilities Act. General Requirements

· Accessibility Policies

· Multi-year Accessibility Plans

· Procuring or Acquiring Goods, Services or Facilities

· Self-Service Kiosks

· Training Staff

Customer Service

· Allowing persons with disabilities to be assisted by support persons, and to make use of assistive devices, as well as service animals

· Establishing feedback processes

Information and Communications

· Feedback

· Accessible Formats and Communication Supports

· Emergency Information

Employment

· Recruitment

· Information for Employees

· Processes to Accommodate Employees

· Workplace Emergency Response Information

Design of Public Spaces

· Exterior Paths of Travel

· Parking

· Obtaining Service

· Maintenance

Appendix 4: Moving Toward a New Accessibility Health Standard

Standards Development Committee

· The Accessibility for Ontarians with Disabilities Act establishes a legislated process for the development of accessibility standards. It requires accessibility standards to be developed by Standards Development Committees with membership comprised of persons with disabilities, affected ministries, and the industries or sectors that would be impacted by the standard in question.

· The standards development process set out under the Act is intended to empower people with disabilities and obligated organizations to work together to provide detailed policy recommendations to government.

· The Standards Development Committee will consider the feedback from the targeted consultations and will develop recommendations to government, including requirements for the identification, prevention and removal of barriers to accessibility in the health care sector.

· Once the Standards Development Committee has developed an initial proposed standard, the public will be invited to provide feedback.

Government Consideration

· Government is required to consider the recommended standard for adoption in regulation in whole, in part, or with modifications. Further public consultation may occur as part of this stage of government consideration.